Provider Demographics
NPI:1518990977
Name:REHABILITATIVE TREATMENT FACILITY INC
Entity Type:Organization
Organization Name:REHABILITATIVE TREATMENT FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENEDYS
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-2402
Mailing Address - Street 1:3534 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1028
Mailing Address - Country:US
Mailing Address - Phone:305-442-2402
Mailing Address - Fax:305-442-2403
Practice Address - Street 1:11180 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1216
Practice Address - Country:US
Practice Address - Phone:305-553-2444
Practice Address - Fax:305-220-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-6873Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY